Surgeons expose hidden costs of a healthcare system built for men

For decades, healthcare has promoted itself as evidence-based. Yet from operating theatres and medical devices to workforce structures and diagnostic pathways, many of the systems underpinning modern medicine were designed around a male default.

That was the central challenge posed at the Medical Technology Association of Australia’s (MTAA) Women’s Health MedTech Summit, where leading surgeons and entrepreneurs argued that healthcare continues to ask women to adapt to systems that were never built with them in mind.

Dr Annette Holian, Orthopaedic and Trauma Surgeon and Clinical Director of Surgery and Peri-operative Services in the Royal Australian Air Force pointed to hospital cultures that continue to reward availability at early-morning meetings and after-hours administrative work, expectations that often conflict with caregiving responsibilities disproportionately carried by women.

“Much of the hospital business happens before the clinical day starts and after it ends,” she said. “For women considering surgery, that’s a significant deterrent.”

While cultural barriers persist, physical design shortcomings remain deeply embedded across surgical practice.

Associate Professor Claudia Di Bella, an orthopaedic surgeon specialising in joint replacement surgery and bone and soft tissue tumours, said many of the tools surgeons use daily were designed with a male operator in mind.

“If you picture an orthopaedic surgeon, most people don’t picture someone who looks like me,” A/Professor Di Bella said. “The vast majority of our instruments are heavy, bulky and difficult to handle with smaller hands. People may assume female surgeons are being clumsy, but often we’re simply using equipment designed for a different body.”

The issue extends well beyond surgical instruments. Operating tables, gowns, microscopes and other equipment are frequently built around male body dimensions, forcing women to compensate physically throughout their careers.

Professor Payal Mukherjee, an adult and paediatric ENT surgeon, said the problem is becoming increasingly visible through emerging ergonomic research.

“We’re investing in training more diverse surgeons, but we’re not getting the full lifespan of those surgeons because many are retiring early with musculoskeletal injuries,” Professor Mukherjee said.

A/Professor Di Bella said female surgeons routinely adapt their techniques and physical movements to compensate for equipment that was never designed for them.

“We’re trying to maintain the same strength, precision and decision-making ability by the fourth or fifth operation of the day as we had during the first,” she said citing research that found women performing joint replacement surgery face a 70% higher risk of upper limb injuries than their male counterparts.

“Many surgeons reach the peak of their careers in their 50s,” she added. “But after years of compensating physically, some struggle simply to keep doing the work they love.”

That loss affects not only individual careers but the next generation of surgeons who lose experienced mentors and teachers.

The discussion also examined growing evidence that female surgeons often achieve superior patient outcomes. Among the most compelling findings is a study of more than one million patients, which found that those treated by female surgeons experienced fewer complications and better overall clinical outcomes than those treated by their male counterparts.

Yet panellists questioned whether healthcare systems continue to reward activity and volume rather than quality.

“If a surgeon takes more time to work up a patient, spends longer explaining options, or even avoids surgery altogether, that can be viewed as a disincentive within the system,” argued Professor Mukherjee. “In many cases, the metrics that matter most are activity and revenue.”

The effect, she argued, is compounded by longstanding leadership structures that continue to associate authority with male surgeons.

“The professors of surgery have traditionally been men. The people training surgeons have traditionally been men,” Professor Mukherjee said. “When authority and leadership are consistently represented that way, it shapes referral patterns, appointments and opportunities.”

Dr Holian described similar challenges throughout her public hospital career. In contrast, she described serving in military deployments as transformational.

“Every day in a public hospital I felt I had to justify my existence as a surgeon,” she reflected. “When I put on a uniform and went to a war zone, I was valued for what I brought to the team and the work I could do. It made me realise how toxic some orthopaedic environments had become.”

The consequences of designing without women was also illustrated in women’s health diagnostics. Associate Professor Michelle Hill, Founder and CEO of ProSeek Bio, highlighted ovarian cancer as a striking example. Her company is developing a highly sensitive blood test designed to better identify which women genuinely require surgery.

“To diagnose ovarian cancer today, a woman often has to have her ovary removed before it can be properly examined,” A/Professor Hill said. “Once it’s removed, you can’t put it back.”

Because non-invasive diagnostic options remain limited, surgery frequently becomes the default pathway.

“As many as four out of five of those surgeries prove unnecessary,” she said. “But the woman has already lost her ovary.”

Citing World Economic Forum research, A/Professor Hill noted that while women live longer they spend approximately 25% more time in poor health than men, with delayed diagnoses contributing substantially to lost productivity.

The global economy loses around US$1 trillion because women are in poor health. Yet despite the opportunity, female founders continue to receive less than 2% of venture capital funding.

“The irony is that women-led companies consistently outperform,” A/Professor Hill stated. “The business case is already there.”

As discussion turned to industry responsibility, panellists repeatedly returned to one theme: representation.

“Women are increasingly in the room,” said A/Professor Di Bella. “The question is whether they’re actually being heard.”

Professor Mukherjee challenged medtech companies to recognise that the profile of healthcare decision-makers is changing.

“The workforce is changing,” she stated. “If industry doesn’t engage with that changing client base, then it’s going to lose relevance. There is a business case for industry to change alongside the people using its products.”

A call for systemic reform

The panellists outlined a series of practical reforms, including transparent hospital appointment processes, equitable pay structures, increased support for women’s health innovation and stronger representation requirements across leadership forums.

Dr Holian recalled discovering that male colleagues across her hospital network were routinely paid above award rates while many women simply accepted standard enterprise agreements. That disparity, she argued, reflected broader structural inequities that remain hidden in plain sight.

A/Professor Hill called on governments and funding agencies to prioritise transformative solutions rather than incremental improvements.

“We need to stop asking only how we keep women alive,” she said. “We need to ask how we improve their quality of life.”

Despite the challenges, the message to aspiring female surgeons was unequivocal.

“Follow your passion,” A/Professor Di Bella said. “Surgery is demanding, but it is also incredibly rewarding. The impact you can have on a person’s life is extraordinary.”

Women entering surgery, she said, must also have honest conversations about how family responsibilities will be shared.

“Too often we expect one person to carry both a surgical career and the full burden of family life,” she said. “That conversation about sharing the load is absolutely critical.”

As the session drew to a close, panellists were asked to nominate one practical action the audience could champion immediately.

Their answers were striking in their simplicity: ask female surgeons how surgical instruments should be designed; ensure women have a seat at leadership and decision-making tables; invest in advocacy for women’s health; and make meaningful female representation a non-negotiable requirement for conference panels and industry forums.

In reimagining healthcare across the entire patient journey, Health Industry Hub^TM is the only one-stop-hub uniting the diversity of the Pharma, MedTech, Diagnostics & Biotech sectors to inspire meaningful change.

The Health Industry Hub^TM content is copyright protected. Access is available under individual user licenses. Please click here to subscribe and visit T&Cs here.